HomePilots & Projects National Demonstration Project NDP Methods & Measures

Methods & Measures

Methods

The Center for Research in Family Medicine and Primary Care, an independent research group based out of Case Western Reserve University, has been engaged by TransforMED to oversee the evaluation of the National Demonstration Project.

The 36 practices selected to participate in the NDP have been randomized into two groups – 18 practices are engaged in facilitated implementation of the TransforMED model; 18 practices are engaged in self-directed implementation. Both groups will be compared to each other and additional comparison data will be sought to compare them to family medicine practices in general.

The NDP evaluation involves a rigorous multi-method assessment of the process of practice change, using a combination of quantitative and qualitative data collection and analysis techniques, as well as outcome assessments using surveys and chart audits.

All demonstration practices undergo an in-depth practice assessment to determine baseline conditions.

facilitated practices
Facilitated practices receive support from TransforMED in the form of tailored implementation strategies, organized change management, integrated software technology and team training. Consultation and support from experts in the areas of practice economics, health information technology, practice management and quality improvement will be ongoing for the duration of the project.

A lead physician and an administrative or clinical support staff member from each practice participate in periodic meetings and conference calls, and a dedicated e-mail discussion group and Web site provide a forum for collaboration between the practices. Participants are encouraged to share best practices with other NDP participants.

self-directed practices
The self-directed practices are evaluated by the same Evaluation Team and according to the same guidelines but receive minimal additional intervention. They will be provided access to practice improvement tools and services via information provided on the Web site. The goal is to evaluate if highly motivated, high-quality practices can transition to the TransforMED Model and see the same improvements without facilitation.

Measures

Metrics used in the evaluation of the National Demonstration Project practices include the following:

• Patient satisfaction
• Physician and staff satisfaction and quality of life
• Clinical process and outcome measures
• Financial impact on practice revenues and physician income

Process and outcome data will be gathered in both the facilitated and the self-directed practices by a research nurse conducting medical record reviews, patient and staff surveys, and direct observation. The TransforMED facilitator will collect additional data on the process of change from practices participating in the facilitated group.

Outcomes will be evaluated based on nationally recognized metrics, including measures developed by the following initiatives and institutions:

» Ambulatory Quality Alliance
» Nursing Care Quality Initiative
» Institute for Healthcare Improvement
» Medical Group Management Association
» American Medical Association

Analyses will use a case study approach to elucidate the process of practice change and to identify key factors that affect the transformation process.

Patient outcomes to be assessed include the quality of chronic disease management, preventive service delivery, acute illness care and mental health care, patient satisfaction and patient-centeredness of care.

Practice outcomes include clinician and staff quality of life, practice processes, and financial viability.

Key learnings will be synthesized and disseminated on an on-going basis among the demonstration sites and within the larger practice community.